The Effects of IV Solution during Cesarean Section on Umbilical Glucose, Electrolyte and Insulin

Park, Jung Goo; Cheun, Jae Kyu; Kim, Ae Ra

Abstract

It is well documented that rapid administration of solution containing dextrose results in marked hyperglycemia and osmotic diuresis. The maternal effect of hyperglycemia caused by rapid administration of dextrose solution may affect the fetus or the newborn baby as well. Therefore, there was a need to ascertain an appropriate IV solution for prehydration in cesarean section. The aim of this study was to determine an appropriate solution for cesarean section based on the results of the effects of matemal IV glucose solution on the newborn's glucose, electrolyte and insulin. 40 parturients scheduled for cesarem section were chosen at random. They were divided into two groups : one group received Hartmann's solution and the other group received 5% D/W. Patients' venous blood was drawn on the operating table prior to starting IV infusion for the measurement of blood sugar and electrolytes(Na, K, Cl) in various conditions of NPO. Then, intra-venous fluid was administered rapidly for prehydration about 20 ml/kg/hr(about 500 ml for 20 minutes) while anesthesia was induced and maintained with an endotracheal tube in place. The second blood samples were taken from matemal vein, umbilical vein and artery immediately after delivery for the measurement of glucose and electrolyte. At the same time insulin levels of umbilical veins were measured. The prehydrative glucose levels were 75.40+/-20.80 mg/dl in group 1 and 78.60+/-12.44 mg/dl in group 2. Both values were within normal range without significant hypoglycemia following the various times of NPO. Posthydration values of maternal glucose in group 2 with glucose infusion was 221.30+/-3.62 mg/dl. This was significantly higher than 72.20+/-7.11 mg/dl in group 1(p<0.05). At the time of delivery, the values of umbilical venous and arterial blood glucose in group 2 were significantly higher than in group 1(p<0.05). The values of insulin in umbilical venous blood in group 2 was 48.09+/-25.54 uU/ml. This was significantly higher than 6.06+/-2.06 uU/ml in group 1(p<0.05). Hydration using either solutions did not affect the value of electrolyte either in the mother or newborn baby. However, the rapid administration of glucose solution increased the maternal and umbilical glucoses as well as umbilical insulin proportionally. As the result of this study, prehydration with the solution containing glucose for cesarean section increased maternal and fetal glucoses as well as fetal insulin levels. Therefore, prehydration with any solution containing glucose is not recommended to prevent maternal and fetal hyperglycemia, and can result in delayed newbom hypoglycemia. It was concluded that prehydration with balanced electrolyte solution without dextrose seems to be safer to babies as well as mothers.